Reforms coming, but health care still problematic

Before you undergo a costly diagnostic or elective procedure, ask your doctor — is this necessary?

Avoiding unneeded or “harmful” health care is a patient’s best way to help get the country’s health care system back on track, according to Dr. Sarah Kemble.

To turn a profit, many health care providers may order unnecessary tests or treatment above and beyond what’s needed. Patients need to be their own advocates, said Kemble, because what’s best for a patient is not always what’s best for providers’ or insurers’ bottom lines.

Kemble, a Vermont primary care physician who for years ran the Community Health Center of Franklin County, recently spoke on the faults of our current health care system, and federal reforms soon to be enacted through the 2010 Affordable Care Act, or “Obamacare.”

One key flaw in our system is the economics of it all, said Kemble.

“The law of supply and demand is reversed in health care,” she told the crowd gathered at Greenfield Community College Thursday.

Rather than a demand creating a need for a supply, the fundamental principle that drives most goods or service-based economies, in health care, the supply creates the demand.

“The philosophy is, ‘if insurance will pay for it, we will build it, whether it helps (patients) or not,’” she said. “Suppliers build and market (equipment), physicians order it, and refer it to patients.”

When needed, medical technology can save lives and improve the quality thereof. The problem is, medical equipment is costly and it’s not providing a return on a provider’s investment if it’s gathering dust.

Large practices with lots of expensive equipment and their own laboratories may be quick to order expensive tests and procedures, knowing that insurers will pay for it.

The best defense against this, said Kemble, is finding a primary care physician who will treat you more like a patient than a source of revenue.

Over-testing and treatment raise costs on the insurer’s end, and those costs are passed on to the insured, through premiums, co-payments and deductibles.

Those premiums, co-pays, and deductibles are out of control and rising, said Kemble, while the efficacy of health care is in decline.

The U.S. health care system, she said, is one of the most costly in the world, and provides worse results than many more efficient systems, be they socialized, subsidized, or regulated by the government.

Though their individual models for health care may vary, Kemble said that a common thread in successful systems is the reliance on primary care physicians, rather than specialists.

In America, those who are healthy and young have an easier time finding coverage than the old or sick, who need health care most, she said. The healthy and insured pay into the system, at high costs, and cost insurers less in payouts.

The Affordable Care Act will impact Massachusetts less than many other states. Several provisions in the Affordable Care Act are already in place in Massachusetts through the state’s health care insurance reform law of 2006, better known as “Romneycare,” named for Mitt Romney, former Republican governor of the Bay State.

These include a mandate that every individual in the state must have insurance or face tax penalties, and a state-run aggregate linking those who can’t get private insurance with subsidized or free care.

Although Massachusetts’ reforms have made health care more accessible, it’s still got its problems, said Kemble.

Those seeking state subsidized insurance must first apply to MassHealth, wait for a denial letter, then apply to the Commonwealth Health Insurance Connector Authority.

Kemble said it’s a confusing, lengthy process, much of which is done online, adding a layer of frustration for the not so computer-savvy.

There is help available, she said. Many health care providers will assist patients in applying for the low-cost care.

David Rainville can be reached at:drainville@recorder.comor 413-772-0261, ext. 279